Robotic arm-assisted knee and hip replacement is a relatively new technology and tool I am excited about. I believe this is the future of joint replacement because it allows the surgeon to know how the implant will fit your joint before we enter the operating room. I also think this technology will create less post-surgical pain because less soft tissue stretching is needed to accomplish the operation successfully and safely. It's been my impression that patients who have undergone robotic arm assisted knee replacement have had less pain compared to those who have undergone knee replacement without the robotic arm. This has not been true for all patients, but for some, it definitely has.
There is now scientific data to support this claim. In June of 2018, a group out of the UK published a study that compared patients who underwent robotic assisted knee replacement with those who underwent conventional knee replacement: "Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty-a prospective cohort study" by Haddad et al in the Bone and Joint Journal. They found less pain, earlier recovery, and earlier time to return home after surgery in those patients who underwent robotic assisted knee replacement.
The other benefit is that registry (long term study) data shows robotic technology for partial knee replacement surgery is more accurate than manual or traditional surgery, resulting in less early failure of the replacement joint, and therefore, less chance for additional surgeries. We do not have data for total knee or total hip available at this time, but the current thinking is that the data will show superiority in some way.
Utilizing the Mako robotic-arm assisted knee and hip replacement (partial or total) allows for an unparalleled level of accuracy and precision for joint replacement. It allows for a personalized, unique surgical plan and implantation that is customized to your anatomy.
How it works:
Here is an animation of a robotic hip replacement:
First, a CT scan of your arthritic joint is taken. A CT scan is a 3D image of the joint. This CT scan is uploaded into the Mako System software and then a 3D model of your joint is created. This 3D model is used to create a pre-surgical plan by performing the joint replacement virtually on a computer screen before you even enter the operating room.
CT scan of a knee that is loaded into the MAKO robotic software
3D model of the knee made from the CT scan
In the operating room, we will have your personalized surgical plan ready to go. Then, specific and small adjustments are made on the computer to how the implant should be positioned in order to match the implant to your specific joint. Once satisfied with how the implant fits on the computer, the robotic arm is given the final position of the implant. Finally, the robotic arm in brought in, and under surgeon control and direction, your joint is precisely prepared so that the virtual plan on the screen is turned into a real plan. This allows for an implant that fits specifically to your hip or knee, bone, ligament, and tendons. This technique should allow for less pain, improved fit, and ultimately improved satisfaction and longevity of your joint replacement. The operation does take a few minutes longer than a non-robotic joint replacement and extra time is spent in the planning phase of the operation.
Omar H. Akhtar, MD